Recent media attention on Ebola patients in the United States has raised a number of debates about the risks of an epidemic spreading here.
While medical officials, including those at the CDC, have worked hard to calm panic and make the public aware of just how Ebola spreads – not through the air, only with direct contact of bodily fluids – and when someone infected can actually spread the disease – only when they themselves have symptoms – many civic officials have continued to insist on “an abundance of caution” in crafting strict public health policies of quarantine. This has led to renewed public debate about the infringement on individual rights in times of mass fear.
All this is nothing new. History shows us that human reactions to disease, especially “uncontrollable” epidemics, remain fairly constant over time.
In my recent book, “Plague and Public Health in Early Modern Seville,” I examine an earlier era (the 16th century) when the public was fearfully worried about another epidemic disease with few real treatment options: bubonic plague. At that time, the medical community was much less unified in its views of what caused plague and how it spread than we are today regarding Ebola. There was a much greater emphasis on unseen mechanisms of contagion, so the quarantine measures were often much more severe.
Officials removed the sick from their homes to place them in plague hospitals, sometimes even when doctors had diagnosed their symptoms as not being plague. The defensive walls built around cities in the medieval era still became defensive mechanisms to monitor travelers coming into the city and deny entry to any who came from places known to be infected with plague.
Individuals who found themselves isolated or banned resisted these official actions, particularly when it impinged on their ability to make a living. In the case of Seville, a compromise was eventually worked out by which officials retained control over quarantine, but individuals could appeal decisions, making their case directly to the public health committee. This created a public health system that effectively balanced both individual and communal interests.
Despite our greater medical knowledge, what is striking is how similar many patterns of response to epidemics continue to be. Early in the epidemic, news reports in Guinea and Sierra Leone of the public’s fear and distrust of officials attempting to put infected people into hospitals parallels earlier resistance of individuals to being removed from their homes and placed in plague hospitals.
The rights of individuals to not be unfairly constrained versus the rights of the community to be protected from the spread of disease remains at the forefront of public debate. The recent public protests of nurse Kaci Hickox against her forced quarantine in New Jersey are directly parallel to protests of many individuals in earlier eras against similar kinds of confinement.
The modern balance emerging in this case is one of very close monitoring for symptoms, but without complete quarantine for those returning to the U.S. from countries affected by Ebola. This enables health care workers who have volunteered their time to help care for Ebola patients to return home and continue their lives and their jobs, while still reassuring the public that there is no threat of a latent contagion.
What is needed is to continue this balance.
Understanding how similar events have affected societies in the past can give us perspective on how to craft reasonable policies today. The reality is that we have yet to master the microscopic world, and Ebola is a great example of an emerging disease. So alongside the very important scientific efforts to understand and treat these diseases, there needs to be an equally strong effort to create public health responses that are both effective and humane.
Kristy Wilson Bowers is an instructor in the NIU Department of History. Her research encompasses various aspects of the history of medicine in early modern Spain. She earned her Ph.D. from Indiana University.